THE ALBERT KENNEDY TRUST

APPLICATION FORM

Trustee / Committee Member

CONFIDENTIAL

Closing date: 5pm on 11th May 2015

Please indicate your specialist area:

Communications / PR / marketing

Community development

Fundraising

Finance

Housing management

Please ensure you include your CV* and completed equalities monitoring questionnairewhen returning this completed application.

*please ensure you keep this document to two pages in length and candidates are requested not to include a photograph

PERSONAL DETAILS

Surname: / Title:
Forename/s:
Home Address:
Home Telephone:
Mobile Telephone:
Email Address:

How would you like us to contact you if you are shortlisted and invited to interview?

Phone

Email

SUPPORTING STATEMENT

In completing the supporting statement please address the role description and person specification included in the information pack; and in particular give evidence you meet the specialist skills area you have selected from page one of this application.

REFERENCES

Please supply contact details for two referees who can vouch for your suitability for the position.

We will only take up references if you are offered the position of trustee, to confirm the information you have supplied.

Surname: / Title:
Forename/s:
Role / organisation:
Telephone:
Email:
May we contact prior to interview?
Surname: / Title:
Forename/s:
Role / organisation:
Telephone:
Email:
May we contact prior to interview?

CRIMINAL OFFENCES

If short-listed you will be asked to declare if you have ever been convicted / cautioned of any criminal offences, and the appointment of successful candidates will also be subject to an Enhanced Disclosure and Barring Service check prior to confirmation in post.

DECLARATION

By submitting your application, you are declaring that the information that you have provided is correct. Providing deliberately false information or withholding relevant details will disqualify you from becoming a trustee. Canvassing of support from AKT staff or trustees will also disqualify your application from being considered.
I, [name] ……………………………………………………………… am applying to be considered for selection as a trustee of AKT and certify that I am eligible to be a charity trustee, being aged over 18, of sound mind and not disqualified by law.
Note: the [Charities Act 1993] disqualifies anyone who:
  • Has unspent convictions for offences involving deception or dishonesty
  • Is an undischarged bankrupt
  • Has at any time been removed as a trustee of a charity by the Charity Commission or a court because of misconduct
  • Is disqualified from being a company director under the Company Directors Disqualification Act 1986
  • Has failed to make payments under a County Court administration order
  • Has failed to make compositions (come to an arrangement) with his or her creditors and has not been discharged.

I confirm that to the best of my knowledge, the information I have provided in this application is correct.
SignatureDate
Please return to (mark the envelope Private & Confidential):
Tim Sigsworth
Chief Executive
The Albert Kennedy Trust
112 Cremer Business Centre
37 Cremer Street
London
E2 8HD
Email:

Data Protection Act 1998

The information that you provide in your application will be used in the selection process (except for the equalities monitoring data). All information about you will be securely held, with access restricted only to those involved in dealing with your application.

Unless you are invited to become an AKT trustee, your data will be kept for 12 months and then destroyed.

By submitting your application, you are giving your consent to your data being stored and processed for the purposes of the selection process.

Equalities monitoring

Please note this form will be detached from your application to ensure anonymity during the selection criteria

AKT’s Equality statement

AKT is committed to providing equality of opportunity in all its activities, and will ensure that all volunteers, paid staff and service users are not disadvantaged on any of the following grounds:

  • Race, colour, culture, ethnic or national origin.
  • Gender
  • Sexuality
  • Gender re-assignment
  • Maternity
  • Marital status, partnership status, or responsibility for children / dependants
  • Disability
  • Age
  • Religious or philosophical beliefs
  • HIV status
  • Physical appearance
  • Class

AKT intends to be an excellent equal opportunities employer and seeks to be known as such. AKT ensures that all volunteers and staff are recruited on the basis of actual and potential ability and personal skills. Exceptions to this policy are those permitted by law.

AKT will endeavour to advertise any volunteering or employment post to as wide an audience as is practicable. All posts for recruitment of volunteers and staff will have a job description, person specification or role profile. The person specification will include skills; experience and ability required to perform the role and will not contain any unnecessary requirements.

Monitoring and evaluation are integral to the effective implementation of any policy. AKT is committed to developing procedures for monitoring and evaluating the implementation of equal opportunities within all aspects of our work. AKT will strive to monitor the effectiveness of the policy and will review its practice, development and promotion periodically. If any person who is affected by the policy wishes to raise any suggestions in relation to it, they should contact their line manager or the Chief Executive. Any necessary changes will be implemented if appropriate.

Equalities Monitoring Form

It’s important to AKT that we have a safe and diverse environment. We would appreciate it if you could give us some information about you, so that we can make sure we’re offering a genuinely positive work opportunity.

Gender

Age

Religion / Faith Sexual Orientation

Baha’I
Buddhist
Christian
Hindu
Jewish
Muslim
Rastafarian
Sikh
Other (please specify )
No religion
Prefer not to say / Bisexual
Gay/Lesbian
Heterosexual
Unsure
Prefer not to say
Gender identity
Is your gender identity the same as the gender you were assigned at birth?
Yes No Unsure Prefer not to say

Ethnicity

Asian / Asian British / Mixed/ multiple ethnic groups / White
Bangladeshi
Chinese
Indian
Pakistani
Any other Asian background, please state: / White and Black Caribbean
White and Black African
White and Asian
Any other mixed / multiple ethnic background, please state: / English / Welsh / Scottish / Northern Irish / British
White Irish
Any other white background, please state:
Black / African / Caribbean / Black British / Other ethnic group
African
Caribbean
Any other Black/ African/ Caribbean background, please state: / Arab
Any other ethnic group, please state:
Travellers / Self Classification
Irish Traveller
Romany/Gypsy
Any other Traveller, Please specify / If you wish, you could describe your ethnicity in your own words.
Please specify your ethnicity:

Disability

Do you consider yourself to be disabled? Yes No Prefer not to say

Please tick whichever apply:

Physical impairment Learning difficulties Mental health

Sensory impairment, please specify: Visual - Blind / Partially Sighted Hearing loss

Long term health condition Any other, please specify

Immigration Status:

Please tick if at any time you’ve considered yourself to be a:

Refugee Asylum SeekerMigrant Worker

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